目的

探讨纤维乳管镜检查分级在乳头血性溢液乳腺疾病中应用的可行性。

方法

对Mokbel's 分级系统略做调整,对617 例乳头血性溢液患者的纤维乳管镜检查资料进行分级,评估纤维乳管镜图像特征分级诊断的准确性。以病理检查结果为标准,对纤维乳管镜分级诊断结果进行比较评价,计算出纤维乳管镜图像特征分级诊断的灵敏度、特异度、阳性预测值、阴性预测值和准确度。采用ROC 曲线对分级诊断进行检测。

结果

根据调整后的纤维乳管镜分级,617 例乳头血性溢液患者中0 级0 例,1 级21 例,2 级71 例(含恶性1 例),3 级386 例(含恶性9 例),4 级43 例(含恶性8 例),5 级96 例(含恶性78 例)。纤维乳管镜分级的灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为89.6%、89.8%、61.9%、97.9%和89.8%。ROC 曲线下面积是0.897,95%可信区间是0.859～0.935。

结论

纤维乳管镜检查分级可用于乳头血性溢液的乳腺疾病,对早期发现乳腺癌、减少乳腺癌的漏诊具有临床参考价值。

Objective

To evaluate the clinical application of classification of mammary ductoscopy (MD) in the diagnosis of breast diseases with bloody nipple discharge.

Methods

Mokbel's MD classification system was adjusted,called MD classification. A total of 617 patients with bloody nipple discharge who underwent MD were classified using the MD classification. The diagnostic accuracy of the MD classification was evaluated. Using the pathological results as the standard,the diagnostic result of the MD classification of the patients was compared,and the sensitivity,specificity,positive prognostic value (PPV),negative prognostic value(NPV) and accuracy were calculated. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of the MD classification.

Results

According to the MD classification,of the 617 cases of bloody nipple discharge,MD grade 1 was in 21 cases,MD grade 2 in 71 including 1 with malignancy,MD grade 3 in 386 including 9 with malignancy,MD grade 4 in 43 including 8 with malignancy,and MD grade 5 in 96 including 78 with malignancy. The sensitivity,specificity,PPV,NPV and accuracy of the MD classification were 89.6%,89.8%,61.9%,97.9% and 89.8%,respectively. The area under the ROC curve was 0.897,and the 95%CI was 0.859—0.935.

Conclusions

The MD classification can be used in bloody nipple discharge and,has a clinical value for early diagnosis and reducing missed-diagnosis for breast cancer.